1. Primary health care in Denmark
WONCA Europe 2016

2. Organisation of health care in DKL
Emergency ward and hospital
Accessible w/o
referral: ENT
opthalmologist
Chiropractor,
Psychologist,
Pharmacist
Dentist
Dietician Podiatrist
Accessible
with referral:
Medical specialist
Physioterapist
Chiropractor
Psychologist Podiatrist
General practitioner
Prevention/
rehabilitation
Patients

3. The primary health care system in DKL
Free access for all regardless of their economic situation
Even demographic distribution of general practitioners
Listed patients
Gatekeeper and pilot to most health care services

4. The Danish national health insurance (1)L
All citizens are covered by the national health insurance
Group 1 = 99.3 % No co-payment in the primary care sector with few exceptions, patients are affiliated to one clinic and they need a referral to other specialists.
Group 2 = 0.7 % Co-payment, but you can choose any GP or other specialist you want without referral. You have a higher co-payment at dentists etc.
Grp. 1
Grp. 2

5. The Danish national health insurance (2)L
Group 1 patients:
Are affiliated to one clinic - other GPs can treat you in emergency situations, e.g. if the practitioner or GP is on holiday
Can choose a new GP every month, the price is 15 $
Only a few percent choose a new GP on their own initiative
The GPs in average have 1,600 affiliated patients

6. The Danish national health insurance (3)L
Patients can choose between any available GP within a distance of 15 km (5 km in Copenhagen)
The GP has to accept the patient if the distance exceeds 15/5 km in some cases
The patient is entitled to choose between at least two GPs
The GP is obliged to pay home visits within the 15 km distance

7. Approximately 33% of Danish GPs are 60+ years old
The Danish GP (1)
Works under the contract between regions and the GP trade union, the organisation of GPs
The GPs manage and equip their own clinics and hire staff (i.e. nurses, lab technicians, secretaries)
2016
Male
Female
50,1 %
49,9 %
Average age
55 years
50 years
Approximately 33% of Danish GPs are 60+ years old

8. Key figures for the GPs in 2016
Types of partnership practices*:
Group practices: 2+ single practices share facilities and staff, have separate patient lists and economy
Partnerships: Common patient list, economy, facilities, staff, etc.
4,500 GPs in Denmark
Number of GPs %
Number of Clinics %
Single practices
33.7
58.3
Partnership practices*
66.3
41.7

9. Key figures for the GPs in 2016
4,500 GPs in Denmark
3,421 self employed
Approximately 300 employed in general practice
753 employed elsewhere e.g. hospitals and abroad

10. The Danish GP (2)
The GP is obliged to have opening hours from 8 am to 4 pm and at least one hour after 4 pm weekly
The GPs run regional “off hours” service country wide (except the capital region since January 2014)
The average work week is 46,1 hours (2014) including “off hours” emergency work

11. The Danish GP (3)
Average annual income is 1,1 million DKK / 148,000 Euros before tax (2014)
Self employed specialists earns 1.5 million DKK / 201,700 Euros
Hospital consultant earns 1,1 million DKK / 148,000 Euros
27 % of the fee is fee for capitation and 73 % is fee for service
The contract contributes 90% of the GP’s income

12. The GP as gatekeeper/gateopener (1)L
The GP is the gateopener and guide on the patient journey to hospitals, other specialists, physiotherapists and psychologists
Practice consultants improve the collaboration between hospitals, municipalities and the GPs
Are partly financed by the GPs and the municipalities
The GPs have 36.8 million contacts yearly
In average each patient contacts the GP 7 times yearly (50 % times, > 70 years 15 times)

13. The GP as gatekeeper/gateopener (2)L
The GP has more than 40 patient contacts daily (in person, by phone or )
The GPs finish 90% of all their contacts on a certain day without referral, but over a longer period 30% of the patients are referred to other specialist, x-rays, training etc.
It is not necessary to have a referral to dentists and chiropractors (and otologists and ophthalmologists)

14. How to become a GP in DKL 6 years medical school 1 year internship
½-1 year General practice internship
4½ years GP specialist training

15. GP – lifelong learning
Average 10 days of post specialisation education per year
Paid for by GPs themselves (part of the service fee is allocated to Fonden for Almen Praksis and reimbursed to GPs taking part in education/training)
Small group based learning is reimbursed
3 days per year is allocated to national defined topics
Reimbursed post specialisation education is mainly organised by Danish College of GPs and GP Trade Union and is sponsor free

16. IT in practice (1)
All GPs in Denmark use one of app 10 different softwaresystems, all follow MEDCom protocol a common IT communication standard used all over the health care system
All GP clinics in Denmark have homepages and consultation
Patient files can be electronically transferred e.g. if the patient change GP clinic

17. IT in practice (2)
Referrals to anywhere in the health care system are electronic (hospitals, other medical specialists, psychologists, physiotherapists, chiropractors, podiatrists)
Reports from anywhere in the health care system are mostly electronic
Non-urgent communication with primary care nurses/elderly care is electronic

18. IT in practice (3)
Prescriptions are done electronically (can still be written on a napkin if necessary)
All prescriptions are nationally accessible by all physicians via Fælles Medicin Kort (FMK)
Primary care nurses can access FMK in order to administer medication
All administered vaccinations are registered in the National Vaccination Register (DDV)

19. Quality in practice (1)
by law GPs are required to follow National Guidelines as issued by the Danish Health Authority
by law GPs are required to follow regional/municipal health related agreements e.g. Programmes for COPD or cancer treatment

20. Quality in Practice (2))
Passing The Danish Quality of Care standard (DDKM) is part of the GPs’ service agreement with the public health care
All GP clinics must complete certification (akkreditering) before 2019

21. Big Data in Practice (1)
by law GPs are required to ICPC code contacts from Health Care Group 1 patients regarding asthma, cancer, COPD, cardiovascular disease, chronic musculoskeletal diseases, diabetes, non-psychotic psychiatric disease and osteoporosis
GPs are required to use these data as part of improving patient care in their own clinics
GPs are punishable by fine if they do no share these data in anonymised form with the regional councils and central health care authorities

22. Big Data in Practice (2)
At the moment the registration of the required data are at a standstill due to legal and IT related issues
Recognizing the importance of clinical data for the quality of care and research the Danish College of General Practioners (DSAM) and the GP Trade Union (PLO) are working on a legally and ethically viable solution